Skip to main content
PMC home page
Gut logoLink to Gut
. 1991 Nov;32(11):1406–1411. doi: 10.1136/gut.32.11.1406

Gall bladder emptying patterns in response to a normal meal in healthy subjects and patients with gall stones: ultrasound study.

P J Howard 1, G M Murphy 1, R H Dowling 1
PMCID: PMC1379178  PMID: 1752478

Abstract

In this study gall bladder emptying patterns in response to a solid meal were studied using ultrasound. A similar triphasic pattern was seen in eight healthy control subjects and eight patients with gall stones, with 'early' and 'late' net emptying phases separated by a period of net refilling with peak postprandial gall bladder volumes occurring at (mean (SD)) 33.1 (17.9) minutes and 27.4 (18.8) minutes in control subjects and patients, respectively. A phase of slower net emptying followed, which was complete at 146 (33) minutes in control subjects and 125 (33) minutes in the gall stone patients (not significant). Superimposed upon this overall triphasic pattern, postprandial gall bladder emptying was punctuated by repeated short lived episodes of filling and emptying. The mean (SD) estimated postprandial bile outputs were 0.83 (0.34) ml/min in four control subjects and 1.2 (1.1) ml/min in seven patients with gall stones. We propose a 'washout' model to reconcile this large turnover of bile with the concentrating and storage functions of the gall bladder and predict that the extent rather than the rate of gall bladder emptying is important in determining stasis of bile in the gall bladder.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bobba V. R., Krishnamurthy G. T., Kingston E., Turner F. E., Brown P. H., Langrell K. Gallbladder dynamics induced by a fatty meal in normal subjects and patients with gallstones: concise communication. J Nucl Med. 1984 Jan;25(1):21–24. [PubMed] [Google Scholar]
  2. Boyer J. L., Bloomer J. R. Canalicular bile secretion in man. Studies utilizing the biliary clearance of (14C)mannitol. J Clin Invest. 1974 Oct;54(4):773–781. doi: 10.1172/JCI107817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Braverman D. Z., Johnson M. L., Kern F., Jr Effects of pregnancy and contraceptive steroids on gallbladder function. N Engl J Med. 1980 Feb 14;302(7):362–364. doi: 10.1056/NEJM198002143020702. [DOI] [PubMed] [Google Scholar]
  4. Cameron A. J., Phillips S. F., Summerskill W. H. Effect of cholecystokinin, gastrin, and glucagon on human gallbladder muscle in vitro. Proc Soc Exp Biol Med. 1969 May;131(1):149–154. doi: 10.3181/00379727-131-33826. [DOI] [PubMed] [Google Scholar]
  5. Doty J. E., Pitt H. A., Kuchenbecker S. L., DenBesten L. Impaired gallbladder emptying before gallstone formation in the prairie dog. Gastroenterology. 1983 Jul;85(1):168–174. [PubMed] [Google Scholar]
  6. Everson G. T., Braverman D. Z., Johnson M. L., Kern F., Jr A critical evaluation of real-time ultrasonography for the study of gallbladder volume and contraction. Gastroenterology. 1980 Jul;79(1):40–46. [PubMed] [Google Scholar]
  7. Everson G. T., McKinley C., Lawson M., Johnson M., Kern F., Jr Gallbladder function in the human female: effect of the ovulatory cycle, pregnancy, and contraceptive steroids. Gastroenterology. 1982 Apr;82(4):711–719. [PubMed] [Google Scholar]
  8. Fisher R. S., Rock E., Malmud L. S. Gallbladder emptying response to sham feeding in humans. Gastroenterology. 1986 Jun;90(6):1854–1857. doi: 10.1016/0016-5085(86)90252-0. [DOI] [PubMed] [Google Scholar]
  9. Fisher R. S., Stelzer F., Rock E., Malmud L. S. Abnormal gallbladder emptying in patients with gallstones. Dig Dis Sci. 1982 Nov;27(11):1019–1024. doi: 10.1007/BF01391749. [DOI] [PubMed] [Google Scholar]
  10. Forgacs I. C., Maisey M. N., Murphy G. M., Dowling R. H. Influence of gallstones and ursodeoxycholic acid therapy on gallbladder emptying. Gastroenterology. 1984 Aug;87(2):299–307. [PubMed] [Google Scholar]
  11. Fridhandler T. M., Davison J. S., Shaffer E. A. Defective gallbladder contractility in the ground squirrel and prairie dog during the early stages of cholesterol gallstone formation. Gastroenterology. 1983 Oct;85(4):830–836. [PubMed] [Google Scholar]
  12. Gurantz D., Hofmann A. F. Influence of bile acid structure on bile flow and biliary lipid secretion in the hamster. Am J Physiol. 1984 Dec;247(6 Pt 1):G736–G748. doi: 10.1152/ajpgi.1984.247.6.G736. [DOI] [PubMed] [Google Scholar]
  13. Hansen W. E., Maurer H., Haberland H. The effect of sham-feeding on gallbladder volume and circulation of bile acids. Hepatogastroenterology. 1982 Jun;29(3):108–110. [PubMed] [Google Scholar]
  14. Holzbach R. T. Gallbladder stasis: consequence of long-term parenteral hyperalimentation and risk factor for cholelithiasis. Gastroenterology. 1983 May;84(5 Pt 1):1055–1058. [PubMed] [Google Scholar]
  15. Ireland M. A., Davies P., Littler W. A. Some aspects of the arterial response to venous occlusion in man. Clin Sci (Lond) 1983 Jul;65(1):1–8. doi: 10.1042/cs0650001. [DOI] [PubMed] [Google Scholar]
  16. KAUFMAN S. A. Stratification (layering) of bile in the normal gallbladder. Am J Dig Dis. 1959 Aug;4(8):634–637. doi: 10.1007/BF02232157. [DOI] [PubMed] [Google Scholar]
  17. Krishnamurthy G. T., Bobba V. R., Kingston E., Turner F. Measurement of gallbladder emptying sequentially using a single dose of 99mTc-labeled hepatobiliary agent. Gastroenterology. 1982 Oct;83(4):773–776. [PubMed] [Google Scholar]
  18. LaMorte W. W., Schoetz D. J., Jr, Birkett D. H., Williams L. F., Jr The role of the gallbladder in the pathogenesis of cholesterol gallstones. Gastroenterology. 1979 Sep;77(3):580–592. [PubMed] [Google Scholar]
  19. Lanzini A., Jazrawi R. P., Northfield T. C. Simultaneous quantitative measurements of absolute gallbladder storage and emptying during fasting and eating in humans. Gastroenterology. 1987 Apr;92(4):852–861. doi: 10.1016/0016-5085(87)90957-7. [DOI] [PubMed] [Google Scholar]
  20. Mack A. J., Todd J. K. A study of human gall bladder muscle in vitro. Gut. 1968 Oct;9(5):546–549. doi: 10.1136/gut.9.5.546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Maudgal D. P., Kupfer R. M., Zentler-Munro P. L., Northfield T. C. Postprandial gall-bladder emptying in patients with gall stones. Br Med J. 1980 Jan 19;280(6208):141–143. doi: 10.1136/bmj.280.6208.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Nakayama F., van der Linden W. Stratification of bile in gallbladder and gallstone formation. Surg Gynecol Obstet. 1975 Oct;141(4):587–590. [PubMed] [Google Scholar]
  23. O'Brien J. J., Shaffer E. A., Williams L. F., Jr, Small D. M., Lynn J., Wittenberg J. A physiological model to study gallbladder function in primates. Gastroenterology. 1974 Jul;67(1):119–125. [PubMed] [Google Scholar]
  24. Pellegrini C. A., Ryan T., Broderick W., Way L. W. Gallbladder filling and emptying during cholesterol gallstone formation in the prairie dog. A cholescintigraphic study. Gastroenterology. 1986 Jan;90(1):143–149. doi: 10.1016/0016-5085(86)90086-7. [DOI] [PubMed] [Google Scholar]
  25. Pomeranz I. S., Shaffer E. A. Abnormal gallbladder emptying in a subgroup of patients with gallstones. Gastroenterology. 1985 Mar;88(3):787–791. doi: 10.1016/0016-5085(85)90152-0. [DOI] [PubMed] [Google Scholar]
  26. Roslyn J. J., Pitt H. A., Mann L. L., Ament M. E., DenBesten L. Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology. 1983 Jan;84(1):148–154. [PubMed] [Google Scholar]
  27. Setchell K. D., Lawson A. M., Blackstock E. J., Murphy G. M. Diurnal changes in serum unconjugated bile acids in normal man. Gut. 1982 Aug;23(8):637–642. doi: 10.1136/gut.23.8.637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Shaffer E. A., McOrmond P., Duggan H. Quantitative cholescintigraphy: assessment of gallbladder filling and emptying and duodenogastric reflux. Gastroenterology. 1980 Nov;79(5 Pt 1):899–906. [PubMed] [Google Scholar]
  29. Shaffer E. A., Taylor P. J., Logan K., Gadomski S., Corenblum B. The effect of a progestin on gallbladder function in young women. Am J Obstet Gynecol. 1984 Mar 1;148(5):504–507. doi: 10.1016/0002-9378(84)90735-x. [DOI] [PubMed] [Google Scholar]
  30. Strah K. M., Pappas T. N., Melendez R. L., Debas H. T. Contrasting cholinergic dependence of pancreatic and gallbladder responses to cholecystokinin. Am J Physiol. 1986 May;250(5 Pt 1):G665–G669. doi: 10.1152/ajpgi.1986.250.5.G665. [DOI] [PubMed] [Google Scholar]
  31. Takahashi I., Nakaya M., Suzuki T., Itoh Z. Postprandial changes in contractile activity and bile concentration in gallbladder of the dog. Am J Physiol. 1982 Nov;243(5):G365–G371. doi: 10.1152/ajpgi.1982.243.5.G365. [DOI] [PubMed] [Google Scholar]
  32. Wheeler H. O. Secretion of bile acids by the liver and their role in the formation of hepatic bile. Arch Intern Med. 1972 Oct;130(4):533–541. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES